DR. GIDDEL G A THOM (NPI# 1700078375) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700078375 |
| Entity Type | Individual |
| Full Name | DR. GIDDEL G A THOM |
| Credential | MD |
| Practice Address |
1515 W Fir St Portales NM 88130-5703 |
| Mailing Address |
Po Box 843 Portales NM 88130-0843 |
| Practice Telephone | 5753566695 |
| Practice Fax Number | 5753565948 |
| Mailing Telephone | 5753566695 |
| Mailing Fax Number | 5753565948 |
| Enumeration Date | 2007-08-16 |
| Last Update Date | 2018-05-07 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0207X |
Pediatrics Specialization: Pediatric Hematology-Oncology |
MD2009-0687 | NM | Allopathic & Osteopathic Physicians |
| N | 2080P0207X |
Pediatrics Specialization: Pediatric Hematology-Oncology |
ME978766 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NM | 73252875 | 05 | |
| FL | MEDICAL LICENCE | ME98766 | 01 |
| Street Address |
1515 W FIR ST |
| City | PORTALES |
| State | NM |
| Zip Code | 88130-5703 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598756264 | Guadalupe M Kennedy | Nurse Practitioner | 1515 W Fir St, Portales, NM 88130-5703 | 2005-11-02 |
| 1033771647 | Lee Le | Dentist | 1515 W Fir St, Portales, NM 88130-5703 | 2019-07-03 |
| 1366918963 | Jonathan Redd | Nurse Practitioner | 1515 W Fir St, Portales, NM 88130-5703 | 2018-10-22 |
| 1386000636 | Michelle Lynn Hawkins | Nurse Practitioner | 1515 W Fir St, Portales, NM 88130-5703 | 2015-12-31 |
| 1588048524 | La Casa De Buena Salud Inc | Local Education Agency (LEA) | 1515 W Fir St, Portales, NM 88130-5703 | 2015-07-18 |
| 1124422597 | Teresa Claire Evan | Nurse Practitioner | 1515 W Fir St, Portales, NM 88130-5703 | 2014-10-14 |
| 1588912893 | William Jacob Divett | Social Worker | 1515 W Fir St, Portales, NM 88130-5703 | 2012-08-16 |
| 1649535527 | Bhargav Chowdary Paleti | Internal Medicine | 1515 W Fir St, Portales, NM 88130 | 2012-07-07 |
| 1023380615 | Katherine M Thatcher | Nurse Practitioner | 1515 W Fir St, Portales, NM 88130-5703 | 2012-01-30 |
| 1871693044 | Penny G Sanders | Counselor | 1515 W Fir St, Portales, NM 88130-5703 | 2006-09-25 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245861319 | Cynthia Alarid | Student in an Organized Health Care Education/Training Program | 1500 S Ave K Station 3, Schroc, Portales, NM 88130 | 2020-01-28 |
| 1649800384 | Gurveen Sandhu | Student in an Organized Health Care Education/Training Program | 1500 S Ave. K Station 3, Shroc, Portales, NM 88130 | 2020-01-22 |
| 1740744226 | Ashley Mcclelland | Student in an Organized Health Care Education/Training Program | 1500 S. Avenue K, Station 3 Shroc, Portales, NM 88130 | 2019-01-29 |
| 1285103218 | Jessica Dianne Terry | Behavior Technician | 743 S Hills Oak Rd, Portales, NM 88130 | 2018-11-20 |
| 1619445822 | Jonna Smith | Marriage & Family Therapist | 44 S Roosevelt Road N, Portales, NM 88130 | 2018-11-06 |
| 1932689254 | Carolina Yanez | Student in an Organized Health Care Education/Training Program | 1500 S. Avenue K Station 3 Shroc, Portales, NM 88130 | 2018-08-16 |
| 1033611918 | Shelley Marie Laya | Student in an Organized Health Care Education/Training Program | 1500 S. Ave K., Station 3, Shroc, Portales Nm, CA 88130 | 2018-03-06 |
| 1750800744 | Sara Rose Mccarty | Student in an Organized Health Care Education/Training Program | 1500 S Ave K Station 3, Shro, Portales, NM 88130 | 2017-09-12 |
| 1528584463 | Calli Bane | Student in an Organized Health Care Education/Training Program | 1500 South Ave. K, Station 3, Shroc, Portales, NM 88130 | 2017-08-22 |
| 1700302890 | Victoria L Young | Speech-Language Pathologist | 1500 South Ave K, Station 3 Shroc, Portales, NM 88130 | 2017-08-21 |
| Find all providers in zip 88130 | ||||
| Taxonomy Code | 2080P0207X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Hematology-Oncology |
| A pediatrician trained in the combination of pediatrics, hematology and oncology to recognize and manage pediatric blood disorders and cancerous diseases. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) was provided by the American Osteopathic Board of Pediatrics. The Certification is no longer offered. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750673661 | Jessica Marie Valdez | Pediatrics | 2211 Lomas Blvd Ne Ste 2222, Albuquerque, NM 87106 | 2011-05-11 |
| 1447461520 | Trisha Simone Tavares | Pediatrics | 201 Cedar St. Se, Suite 4660, Albuquerque, NM 87106 | 2007-05-24 |
| 1235146275 | Jami Dalene Frost | Pediatrics | 4101 Indian School Rd Ne, Albuquerque, NM 87110-3988 | 2006-08-02 |
| 1043226780 | Linda J Butros | Pediatrics | 1804 Carlisle Blvd Ne, Albuquerque, NM 87110 | 2006-08-01 |
| 1760404255 | Prasad Mathew | Pediatrics | Ambulatory Care Ctr Fl 3, 2211 Lomas Blvd. Ne, Albuquerque, NM 87131-0001 | 2006-07-24 |
| 1104140086 | Amy Cruickshank | Pediatrics | 2211 Lomas Blvd Ne, Albuquerque, NM 87106-2719 | 2010-03-20 |
| 1295822302 | John Kuttesch | Pediatrics | 2211 Lomas Blvd Ne Fl 3, Albuquerque, NM 87106-2719 | 2006-10-09 |
| 1164439121 | James Vance Mckinnell | Pediatrics | Department of Pediatrics Msc10 5590, 1 University of New Mexico, Albuquerque, NM 87131-0001 | 2006-08-02 |
| 1285641225 | Richard Heideman | Pediatrics | 2211 Lomas Blvd Ne, Ambulatory Care Center 3rd Floor, Albuquerque, NM 87106-2719 | 2006-08-02 |
| 1154369981 | Sam W Lew | Pediatrics | 1007 N Pope St, Silver City, NM 88061-5161 | 2006-06-03 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.